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The Australian government has proposed changes to the Medicare levy surcharge. Since 1997 high-income Australians have faced a 1% tax penalty if they did not purchase private health insurance. The proposal has been the subject of much debate in the media and a parliamentary inquiry. It faces opposition in the Senate where the government does not have a majority.
The Australian Government has made plans to sell the private health insurance company it owns, Medibank Private. However, doubts have been raised about who actually owns the company and, in light of opposition to the sale and the imminent sale of a government owned communications company, Telstra, the government has delayed these plans until 2008 at the earliest.
Currently, private health insurance (PHI) only covers care performed in-hospital. Hence, many patients seek in-hospital treatment when more efficient out-of-hospital services exist for a particular treatment. The Government is proposing to enable PHI companies to design products that offer people more choice to purchase cover that better suits their health needs. For example, the new PHI products may cover a person with cancer to have chemotherapy in or out of hospital.
The Coordinated Care Trials are regional projects to test whether multi-disciplinary care planning and service coordination leads to improved health and well-being for people with chronic conditions or complex care needs. Some also involve ?funds pooling? between Commonwealth and State/Territory programs to provide funding flexibility for this coordinated approach to service delivery. Following a first round of 13 trials (1997-2000) there are now five second round trials.
The Report of the Community Consultations, about the National Strategy for and Ageing Australia (February 2002), summarises feedback from individuals and groups throughout Australia. In all there were 15 consultation meetings during 2002, across all 8 States and Territories, attended by the Minister for Ageing. The consultations were to (a) gain broad stakeholder support for the Strategy, and (b) to gather specific ideas about how to implement the Strategy.
Planning in Austria is based on volumes and activity of hospitals and since recently extends to other care sectors. Balancing supply proves difficult owing to fragmented responsibilities in health care. The impact of intensified planning activities on hospital cost growth appears limited in recent years. The effectiveness of supply planning needs to be enhanced by fitting in cost and quality data. More fundamentally, capacity will only become balanced when governance problems are being tackled.
Proposed ambulatory care centres aim to better balance utilization and integration of inpatient and outpatient care. EU rulings required the government to align inconsistent market authorization for ambulatory care providers. But the proposal does not tackle fragmented jurisdiction and diverse payment schemes across providers. Only physicians may become shareholders and they are prohibited from employing other doctors, raising doubts about the usefulness and cost-effectiveness of the policy.
Canada is one of the few developed countries without an option for private payment for delivery of services covered by the public system. However, in some Provinces there has been a slow but steady progression of private delivery and the possibility for patients to pay privately for services that are also covered under the public health care system in response to concern about the sustainability of the current system. Some Provinces have adjusted legislation to sanction private payment/delivery.
The Report of an advisory committee to the Government of Quebec, chaired by Mr. Jacques Ménard, raises concerns about the long term sustainability of the provincial health and social services system and, more importantly, about intergenerational equity. Among other things, the Menard Report calls for more private delivery and the creation of a separate pension-like scheme to fund services that citizens require when they lose their autonomy, that is to say long-term care and home care.
In June 2005 the Supreme Court of Canada ruled (4-3) that Quebec's legislation banning the purchase of private insurance for services already insured under the public insurance system violated the Quebec Charter of Rights. The court was evenly split (3-3, with one abstention) on the question of whether the Quebec legislation violated the Canadian Charter of Rights (the nation's constitutional bill of rights).